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Cognitive–behavioural therapy (CBT) is recommended for all patients with psychosis, but is offered to only a minority. This is attributable, in part, to the resource-intensive nature of CBT for psychosis. Responses have included the development of CBT for psychosis in brief and targeted formats, and its delivery by briefly trained therapists. This study explored a combination of these responses by investigating a brief, CBT-informed intervention targeted at distressing voices (the GiVE intervention) administered by a briefly trained workforce of assistant psychologists.
To explore the feasibility of conducting a randomised controlled trial to evaluate the clinical and cost-effectiveness of the GiVE intervention when delivered by assistant psychologists to patients with psychosis.
This was a three-arm, feasibility, randomised controlled trial comparing the GiVE intervention, a supportive counselling intervention and treatment as usual, recruiting across two sites, with 1:1:1 allocation and blind post-treatment and follow-up assessments.
Feasibility outcomes were favourable with regard to the recruitment and retention of participants and the adherence of assistant psychologists to therapy and supervision protocols. For the candidate primary outcomes, estimated effects were in favour of GiVE compared with supportive counselling and treatment as usual at post-treatment. At follow-up, estimated effects were in favour of supportive counselling compared with GiVE and treatment as usual, and GiVE compared with treatment as usual.
A definitive trial of the GiVE intervention, delivered by assistant psychologists, is feasible. Adaptations to the GiVE intervention and the design of any future trials may be necessary.
In the context of increasing recognition of the role of nature in well-being, but limited evidence for specific patient groups, we describe a mixed-methods evaluation of a 10-week green care intervention (a woodland group) for 18- to 30-year-olds who had experienced a first episode of psychosis. Data were collected using the Questionnaire on the Process of Recovery (QPR), semi-structured service evaluation questionnaires, the NHS Friends and Family Test (FFT), and focus group analysis.
All participants present at week 10 (n = 5) would recommend this group to others; 4/8 participants showed reliable improvement on QPR outcome measures. Thematic analysis identified themes of connection with nature and others, development of a sense of well-being and ‘peacefulness’ and new perspectives on psychotic experience.
This small retrospective evaluation describes patient-reported benefits, feasibility and acceptability of green care interventions within early intervention in psychosis services (EIS).
Recognition of the essential role of nature-based activities for general wellbeing is expanding. Previous evaluation of nature-based activities has shown that those with greater mental health needs may benefit proportionally more compared to the general population. Currently, there is limited evidence of the benefits of green care for those with severe and enduring mental illness, including psychosis.
We aim to establish benefits and difficulties encountered during a 10-session green care programme for 18-30 year olds who have experienced first episode of psychosis (FEP) using a mixed methods approach.
This was a service evaluation of the Woodland Group, run by Circle of Life Rediscovery (CLR) and commissioned by Sussex Partnership NHS Foundation Trust in Autumn 2019 for 10 half-day sessions. All participants were aged 18–30 years, referred from Early Intervention in Psychosis service and had experienced FEP. Patients were supported by EIS staff with a ratio of at least 3:1. Sessions consisted of a welcome and agenda setting, ice-breaking activity, core nature-based activity (such as roasting chestnuts, maintaining the woodland area) and a ‘sense meditation’.
Quantitative data for this evaluation were collected through routinely collected 15-item Questionnaire on the Process of Recovery (QPR), and a semi-structured intervention experience questionnaire. Qualitative data were collected via a focus group within the final session of the Woodlands Group. Thematic analysis was performed by the three co-authors.
Session attendance ranged between 3-15. 4/8 patients showed reliable improvement on QPR outcome measures, 1 showed deterioration and 3 showed no change. Mean QPR scores showed modest increase from average 3.4 (week 1) to 3.8 (week 10). 100% of respondents would recommend this group to others. Thematic analysis identified themes of connection with nature and others, development of a sense of wellbeing and ‘peacefulness’ and new perspectives on psychotic experience.
This small, retrospective evaluation is the first to investigate green care interventions for young people experiencing FEP. Our results reflect the positive informal feedback from participants and supporting staff following attendance at the Woodlands Group. Limitations include small sample size, incomplete data, and reliance on patient-reported outcomes. These findings show promise for green care activities within EIS and represents a sustainable intervention in mental health care.
The SUPEREDEN3 study, a phase II randomized controlled trial, suggests that social recovery therapy (SRT) is useful in improving functional outcomes in people with first episode psychosis. SRT incorporates cognitive behavioural therapy (CBT) techniques with case management and employment support, and therefore has a different emphasis to traditional CBT for psychosis, requiring a new adherence tool.
This paper describes the SRT adherence checklist and content of the therapy delivered in the SUPEREDEN3 trial, outlining the frequency of SRT techniques and proportion of participants who received a full therapy dose. It was hypothesized that behavioural techniques would be used frequently, consistent with the behavioural emphasis of SRT.
Research therapists completed an adherence checklist after each therapy session, endorsing elements of SRT present. Data from 1236 therapy sessions were reviewed to determine whether participants received full, partial or no therapy dose.
Of the 75 participants randomized to receive SRT, 57.3% received a full dose, 24% a partial dose, and 18.7% received no dose. Behavioural techniques were endorsed in 50.5% of sessions, with cognitive techniques endorsed in 34.9% of sessions.
This report describes an adherence checklist which should be used when delivering SRT in both research and clinical practice. As hypothesized, behavioural techniques were a prominent feature of the SRT delivered in SUPEREDEN3, consistent with the behavioural emphasis of the approach. The use of this adherence tool would be considered essential for anyone delivering SRT looking to ensure adherence to the model.
Social disability in youth is an important precursor of long-term social and mental health problems. Social inclusion is a key policy driver and fits well within a new paradigm of health and well-being rather than illness-oriented services, yet little is known about social inclusion and its facilitators for “healthy” young people. We present a novel exploratory structural analysis of social inclusion using measures from 387 14- to 36-year-olds. Our model represents social inclusion as comprising social activity and community belonging, with both domains predicted by hopeful and dysfunctional self-beliefs but hopefulness more uniquely predicting social inclusion in adolescence. We conclude that social inclusion can be modeled for meaningful comparison across spectra of development, mental health, and functioning.
Background: Hearing voices can be a common and distressing experience. Psychological treatment in the form of cognitive behavioural therapy for psychosis (CBTp) is effective, but is rarely available to patients. The barriers to increasing access include a lack of time for clinicians to deliver therapy. Emerging evidence suggests that CBTp delivered in brief forms can be effective and offer one solution to increasing access. Aims: We adapted an existing form of CBTp, coping strategy enhancement (CSE), to focus specifically on distressing voices in a brief format. This intervention was evaluated within an uncontrolled study conducted in routine clinical practice. Method: This was a service evaluation comparing pre–post outcomes in patients who had completed CSE over four sessions within a specialist out-patient service within NHS Mental Health Services. The primary outcome was the distress scale of the Psychotic Symptoms Rating Scale – Auditory Hallucinations (PSYRATS-AH). Results: Data were available from 101 patients who had completed therapy. A reduction approaching clinical importance was found on the PSYRATS distress scale post-therapy when compared with the baseline. Conclusions: The findings from this study suggest that CSE, as a focused and brief form of CBTp, can be effective in the treatment of distressing voices within routine clinical practice. Within the context of the limitations of this study, brief CSE may best be viewed as the beginning of a therapeutic conversation and a low-intensity intervention in a stepped approach to the treatment of distressing voices.
Background: Although recommended in national treatment guidelines, there is much that is still unknown about CBT for psychosis (CBTp) in terms of the process and experience of the therapy. One way to investigate these gaps in knowledge is to explore service users' experiences through qualitative research. Aims: To consolidate existing qualitative explorations of CBTp from a service user perspective. Method: Qualitative synthesis and comparison with previous research findings. Results: Two analytical themes were created from initial descriptive themes common to multiple studies: “The ingredients in the process of therapy” and “What is the process of therapy?” Conclusions: Qualitative synthesis is a useful method for generating new insights from multiple qualitative studies. Service user perspectives on CBTp corroborate existing research and may also offer more novel findings regarding the ingredients and process of therapy. However, qualitative studies are limited in number and do not always maximize the prominence of service user experience.
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